Mashantucket Pequot Tribal

NPI #1720024524 in Mashantucket, Connecticut

Provider Information

NPI Number: 1720024524
Entity Type: Organization
Organization Name: Mashantucket Pequot Tribal
Subpart: Yes (part of a larger organization)
Parent Organization: MASHANTUCKET PEQUOT TRIBAL
Primary Specialty: Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Enumeration Date: Jun 21, 2006
Last Updated: Apr 16, 2025

Practice Location

Address: 1 ANNIE GEORGE DRIVE
Address 2: BLDG 1
City: Mashantucket
State: Connecticut
ZIP Code: 06338-3801
Phone: (860) 396-6435

Authorized Official

Name: DR. JOHN GROSSOMANIDES, PHARMD, RPH
Title: DIRECTOR OF PHARMACY SERVICES
Phone: (860) 396-6435

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pharmacy	333600000X
Pharmacy - Mail Order Pharmacy — Mail Order Pharmacy	3336M0002X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy	332800000X	Primary

Similar Providers

Individual Providers

Provider Name	Specialty	City
MRS. Amy D Ricupero, RPH, MED	Pharmacist	Mashantucket	AI Deep Dive
Catherine Ann Koivisto, RPH	Pharmacist	Mashantucket	AI Deep Dive

Organizations

Provider Name	Specialty	City
Mashantucket Pequot Tribal	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy	Mashantucket	AI Deep Dive
Mohegan Tribe of Indians of Ct	Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy	Uncasville	AI Deep Dive
Mashantucket Pequot Tribal	Pharmacy - Mail Order Pharmacy	Mashantucket	AI Deep Dive

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